Cancellation and Missed Appointment Policy
Thank you for choosing Acupuncture Therapy, as a modality to better enhance your health. In order to provide all patients the best possible care, it is requested to review this policy regarding missed appointments. In order to be respectful of the medical needs of other patients, please be courteous and call if unable to show up for an appointment. Respectfully, understanding this policy permits a greater utilization, to reallocate time to patient in need of medical care.
A missed appointment is when one fails to show up for an allotted appointment time, without a phone call or cancellation notice of at least 24-hours. Please remember this time has been reserved for individualized attention. Therefore, kindly it is requested to provide at least a 24-hour notice, in order to reschedule the appointment, while avoiding a missed appointment fee. If you fail to give notice of your appointment being missed within 24 hours of the scheduled appointment time, one will be charged a $25 missed appointment fee. Same day cancellations are considered from 12:00am, to the day and time of service, a $35 fee will be applied. If you do not call to cancel your appointment, or fail to show up for the scheduled appointment, one will be charged $50 for the scheduled service. This is considered the “No Call No Show Policy”. However, this fee may or may not be waived if the appointment is rescheduled and attended within three days of the missed scheduled time.
No Call No Show Policy:
A “no-call/no-show” is someone who misses an appointment without cancelling it in an adequate manner. A failure to be present at the time of a scheduled appointment will be recorded in your medical record as a “no call/no-show.” A $50 fee will be enforced.
How To Cancel Your Appointment:
To cancel appointments, please call 937-245-1799, especially after 6:00pm and on the weekends. You may also call the office 440-777-2811 prior to the 48-hours of the scheduled appointment time. If no contact is made, please leave a detailed message on voicemail. If you would like to reschedule your appointment, please leave your phone number. Your call will be returned in order to provide the next available appointment time.
As a courtesy upon request, a phone call, text message, and/or e-mail (please circle preferred method) will be sent to confirm the scheduled appointment two-three business days prior to your appointment date. However, one is unable to be reached a message will be left provided there is an active voicemail. Please understand that it is your entire responsibility to remember your appointment date and time. This charge is not covered by insurance. Your phone call is critical in helping to provide continuous care to all valued patients.
By voluntarily signing this form, I show I have read, or have had read to me, the above policy. Additionally, I understand and I will be held responsible for any fee that is administered to missing, canceling, or failing to arrive at the scheduled appointment time.
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I would NOT like to receive newsletter from McClure Acupuncture. (No)
Cancellations prior to 24 hours: $25
Same day cancellation: $35
No Call/No Show: $50
Signature and Date: _________________________________________________________